Working out with depression

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

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    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

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    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

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    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

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Strategies for working with depression in Gestalt therapy

A strategy for the therapeutic transformation of relationships with depression, or why hamsters prefer to live in cages.

- You live like a pig, master!
- I was depressed.
- So it's depression, not paralysis...

M. Weller

No matter how much people now talk about the fact that depression has become a common occurrence in our day, this does not at all alleviate its painful symptoms. No matter how well it is diagnosed and no matter how much work is published on the nature of depression, it is almost impossible for a person in this grave condition to get out of it on their own.

Almost. And this is good news! We can only do what is possible for us, and the impossible will catch up. I want to clarify my point - in a large number of cases, depression can be dealt with on your own, and - which makes the task easier - with the help of a psychologist, for example, a Gestalt therapist.

So what is possible for a depressed person? What is impossible? The simplest answer that can come to mind for a person who is depressed for most of the day, has lost interest and the ability to enjoy, feels tired and loses energy almost daily is: “Lie down and die.” Paradoxically, this is the answer to both questions. A person in this state can neither cope with sadness and depression, regaining his joy and interest in life, nor finally come to terms with his worthlessness, weakness, guilt, helplessness ... It turns out that “lying and dying” is at the same time possible and impossible.

I hope to return to the topic of the benefits of facilitation and process transformation in another article. In the meantime, I remember the old logical puzzle about an indestructible pillar and an all-destroying core. What will happen if they meet?
In search of an answer to this question, your mind will become more and more entangled, you will be more and more firmly established in the vicious circle of your own stereotypes of thinking, if ... Let's leave the question open for now and return to this a little later.

But it seems that life itself does not skimp on such puzzles... But what does life have to do with it? In this case, we are dealing with a certain way of thinking: thoughts are triggered automatically. These thoughts are listed more than once in various reference books and textbooks, and they are called “automatic”. Sometimes they turn into "depressogenic beliefs", but the essence of the subject does not change from this. So, I will briefly review a far from complete list of them:

  1. I feel that the whole world is against me.
  2. There is nothing good in me.
  3. I can't do anything?
  4. Nobody understands me.
  5. I upset people
  6. I can't seem to do it anymore.
  7. I would like to be a different person.
  8. I am so weak.
  9. My life is not going the way I want.
  10. I am completely disappointed in myself.
  11. Nothing pleases anymore.
  12. I can't take it anymore.
  13. etc.
    (according to M. Williams, J. Tisdale and others)

If you look closely, each of these attitudes contains a hidden, very well-disguised need. In it lies the key to unraveling all the mysteries of the depressive state. Only a person who has fallen into a vicious circle of his way of thinking and perception is not able to take a closer look. Attention is scattered, there is not enough concentration and concentration, unfortunately. (For self-help, I highly recommend the practice of meditation here, but more on that another time.)

I have a favorite English proverb, it says: "When there is a storm on the sea, there are many smart ones on the shore. " And it's good that there is a shore. Let's try to take a close look at any of these beliefs "from the shore". For example, "no one understands me." What is the hidden need here? Take your time. Probably not the one that catches the eye. That's why she's hidden. When a person wants to be understood, what is he doing? Probably, first he determines the subject of understanding: “What do I want to convey?”, And then, probably, he cares about the language in which this something needs to be conveyed, because people live in different languages ​​... From practice, I can say that many people suffering from depression , far from such vigorous activity and "concern about". They passionately want to be active in sympathy and care from near and far. And after all, such active care and “rescue” heal. At first. Until the depression turned into a chronic form and began to serve the "secondary benefit." Remember that joke about the frog? “The latest research shows that licking frog sweat can cure depression. Only when you stop licking it, the frog gets depressed again”...

Without noticing it, a person receives a tool for "extracting love from others." With the second or more times, the tool becomes dull, it becomes impossible to work with it, uncomfortable, painful ... But there is no other.

Returning to the attitude “No one understands me” or, in an understandable translation, “I want love”, I dare, again from practice, to declare that those who do not love themselves do not receive love. Fresh thought, isn't it? But from this it does not lose its relevance. The recipe for happiness is simple, but it is difficult to implement: Happiness = Love + Unconditionality.

Everyone who is depressed craves one or more of the ingredients in this recipe. The only problem is that he is waiting for this - from the environment. The famous Gestalt therapist Paul Goodman wrote: “There is no such function in any organism that would not be involved in the environment in the most essential way. And vice versa, the real environment, the place, is what is chosen, organized and adapted by the organism.

This is what happens: if you want love - love, if you want unconditionality - do not set any conditions for anyone, in a word, if you want to be happy - be it. After all, happiness is not what a person has, but what he experiences at the same time.

Therefore, if we help ourselves or others out of depression, we make sure to devote time and effort, a lot of time and effort, to working out the defense mechanisms that keep a person from "doing" what corresponds to his request to be loved and happy. Here it happens in different ways: either the request is not clear (confluence of the first kind), or I wait for them to guess (confluence of the second kind), or “if I was good for something, I could do it” (introjection) , either “I don’t need anyone” (a projection of pure water), or I’m simply afraid to talk about my need for affection - I’ll manage somehow (retroflection). There are many variations here - the strategy is one: you need to be aware of the leading need, as well as what prevents it from being satisfied, or rather, to say: “how I prevent myself from satisfying it.”

A scene from Andrei Tarkovsky's famous film comes to mind here. The stalker, risking his life, at the cost of the most severe overcoming, reaches with his "clients" the room for the fulfillment of cherished desires. He doesn't go there. Never. Why? The answer is as simple as it is cryptic: No wish is to be made in this room. Fulfilled themselves: cherished. Master went there one day and woke up a millionaire. And he couldn't bear it. Not what he expected from himself ...

Our task is to help a person realize his real need, since it is precisely this need that can be called the core around which balance is created in the body-environment field. Needs are nothing but the very life force that drives a person in his development and supports his will to live.

Gestalt therapy, in contrast to the psychoanalytic approach, believes that a person is free in his will. He can choose how to behave without being severely limited by his instincts. And at the heart of such a free choice are precisely the needs that can be realized. Choice is aimed at satisfying needs, not at fighting them.

The need, which is currently the most relevant and distinguished from other, background needs, must be satisfied immediately (in Gestalt therapy this is called a figure), otherwise it runs the risk of “hanging” in the background, becoming neurotic or leading to depression. Realizing his real desires, a person organizes his behavior in accordance with them, becomes adequate to himself and interacts with the environment in a way that satisfies him. It is always very important for a therapist to understand how the interaction of a depressed person with a need is organized.

Typically, the depressive patient experiences the lack of love or attachment as an unconscious sadness. He does not grieve over the loss, does not part with what is especially valuable to him (attachment to a loved one, to values, etc. ). This unbearable (or devalued by significant relatives) sadness is the trigger of a depressive reaction. Meanwhile, if a person consciously experiences sadness, he believes in the support of others and accepts it. Then there is no depression.

Some famous person said: "Depression is a state of absence of sadness where sadness would be appropriate."

So, back to the children's problem. What do we need to solve it? Everything is as simple as possible: consistency. Well, these two concepts cannot exist in one given: indestructible and all-destroying. The problem is not solved under such an incorrect condition. A vicious circle is obtained. Eliminate the inconsistency of thinking - solve the problem. Either there is no such pillar, or there is a core. Choose. How does it say? To solve a problem means to understand it. It’s the same with depression – I want something, I don’t know what, and I do everything (or do nothing) for this. Come on, solve this puzzle! Here you can not do without awareness of the need - once, and without coordinating behavior with the need - two.

Let's sum up by outlining the focus of therapeutic work with a depressed client:

1. We establish contact, develop motivation for psychotherapeutic work.

Soon the fairy tale is told, but the deed is not soon done - it takes time and special support for a person to want to change something in his life. It is like a foundation for building a house.

I can't help but remember our pet hamster, who was frantically chewing on the bars and desperately trying to lift the cage door with his nose, striving for freedom. When they let him out, he just as persistently began to look for his feeder and did not calm down until they put it outside. Then he climbed into it with all his paws, and he frankly didn’t give a damn where he would be carried in this feeder. Though back to the cage - it does not matter. If only not to lose his usual feeder.

2. Recognize the basic need, formulate a real request.

This is painstaking work, but it is precisely this that determines the direction of all our psychological activity. It is like the quality of cement for building a house. It is here that it is decided whether we will go along the right or wrong path with our client. (I don't really like this commercial name of the person I work with, but in the context of the definition of the request, it is more or less appropriate).

3. We strengthen "compliance", that is, we bring the action in accordance with the request.

At this stage, as I already mentioned, we will work with defense mechanisms that prevent a person who is in a state of depression from building behavior that is adequate to satisfy the “bursting” need. These are our bricks, logs, blocks - in a word, the main building material. Having collected information about the ways of a depressed person, how he prevents himself from being happy (mechanisms of resistance), we get access to the building material, that is, the organization of the transformation process as such (contact).

4. At the same time, do not forget from time to time to “use a level and a plumb line”, check the “quality of the supplied material”, namely:

  • reduce the level of anxiety (recognize fears and learn to deal with them)
  • we increase the level of field independence (we transfer the locus of control to ourselves, we stop seeing the causes of our troubles in circumstances and other people)
  • realizing the hidden meaning of the symptoms of depression (the so-called "secondary benefit" from suffering is our hamster's feeder; here it is important to replace the feeder in the cage with honestly discovered treasures - with the conscious use of the experience gained)
  • the distinction between responsibility and guilt (this is an interesting topic in itself, deserving special attention). However, I will note here the retroflexive nature of self-accusation and the effective, active nature of responsibility. This is important because healing (in gestalt therapy, psychodrama, somatic therapy of trauma and other psychotherapeutic approaches occurs through active action, through the body and the development of new forms of response)

5. Cognitive elaboration of the predicted future.

To implement any - grandiose and not very - projects, it is necessary to complete the unfinished in the past and live what is happening in the present. Otherwise, the roof, waiting under tons of construction waste, will not be able to be found and erected in its proper place.

6. The last thing that is important to pay our attention to is working with awareness, new meanings, a fresh vision of the meaning and value of life. OTC, so to speak. The house was built and put into operation.

When needs and mechanisms that hinder their realization are realized, all conditions are created in order not to reduce the tension and value of the previously frustrated need by devaluing one's existence and losing the meaning of life. You can look for ways to satisfy it by expanding your role repertoire and enriching the tools for transforming reality.

So instead of a cage, we built a new house for our hamster. Only one assumption - it must be on his own design. In other, human, words, we made a cursory revision of our capabilities in helping people who are depressed. I really hope that it was useful for you to read my thoughts and generalizations on this topic, both for psychologists and for those who are familiar with depression not by hearsay, but from their own experience. The topic is interesting, necessary, I hope to return to it in future articles. But in other perspectives - psychodramatic, somato-traumatic-therapeutic and Bodynamic. I wish you health and happiness.

Author: Sviridkina Tatyana Leonidovna


How to deal with depression?

In this text I will tell you what are the approaches in psychology to work with depression and how many basic stages in the psychotherapy of this disorder.

It is important to understand that many psychotherapists combine methods and use different approaches. There are no universal patients with a universal clinical picture - with each one it is necessary to build an individual strategy of work. If we divide psychotherapy into main approaches, then there are four of them:

  1. Psychodynamic
    The main goal is to help the person become aware of repressed emotions and memories. With this approach, dreams, slips of the tongue, associations, memory, and forgetting can be analyzed. The therapist helps to release repressed energy in order to find the causes of the depressive state.
  2. Existential
    This approach asserts that a person's experiences arise from the "individual-society" relationship. Society, the whole world are global, it is difficult to know them and integrate into them, a person feels small, insignificant. A person feels globally alone and alienated from everyone.
    Psychotherapists say that a person distances himself from society and goes into an unreal world of his own, simplified and very understandable.
    As a result, a person does not understand what he lives for, cannot find the meaning of life.
    The task of a psychotherapist is to help a person:
    • reconsider moral values;
    • realize their own importance;
    • accept yourself in the real world;
    • form an adequate self-esteem;
    • determine the meaning of life.
  3. Humanistic
    The essence of the approach is belief in the ability of a person: each and every one is able to solve their problems if they know the right incentives.
    With this approach, it is important for a psychotherapist to free a person from uncertainty, fear of failure. A person works out complexes and is ready to solve problems independently.
    The specialist during the sessions creates an atmosphere in which the client must feel self-confidence, speak freely, honestly about his emotions. At this time, the therapist focuses not on what was said, but on the person's emotions at these moments.
  4. Cognitive Behavioral
    This is the youngest teaching in psychotherapy.
    The technique is aimed primarily at human behavior. The purpose of such therapy is to train a person to adapt and behave properly when he or she is faced with negative emotions or circumstances.
    Cognitive therapy claims that the causes of depression are not hidden somewhere deep: disorders happen due to disturbed thinking.
    The psychotherapist helps to solve the specific problems of each client and form new, adequate and constructive patterns of behavior. Specialists use several practices in sessions: